John Mark Jackson
Counselor, Addiction (Substance Use Disorder) in Pueblo, CO. Individual provider (NPI-1).
NPI number1235779166
StatusActive
Last updated in NPPESJan 8, 2020
Details
- NPI
- 1235779166
- Entity type
- Individual (NPI-1)
- Name
- John Mark Jackson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 8, 2020
- Certification date
- Jan 8, 2020
- Last updated
- Jan 8, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
3470 Baltimore AvePueblo, CO 81008-1520
Phone 719-545-1181
Mailing address
208 Circle Dr WCanon City, CO 81212-2439
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 120 Addiction (Substance Use Disorder) Counselor providers in Pueblo · All 5,060 providers in Pueblo
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